From Concept to Measurement: Core State Indicators for Monitoring Preconception Health

1. From Concept to Measurement:Core State Indicators for Monitoring Preconception Health William M. Sappenfield, MD, MPH State MCH Epidemiologist Office of Surveillance, Evaluation & Epidemiology Division of Family Health Services

2. Topics to be Discussed • Purpose • Process • Product • Possibilities

3. 4 5 6 7 8 9 10 11 12 Central Nervous System Central Nervous System Heart Heart Arms Arms Eyes Eyes Legs Legs Teeth Teeth Palate Palate External genitalia External genitalia Ear Ear Mean Entry into Prenatal Care Missed Period We Currently Intervene Too Late Critical Periods of Fetal Development

4. Perinatal Periods of Risk

5. PPOR Analysis of 2000-2002 of data from the 66 largest cities, suggests that preventive action must address maternal health prior to conception and early in pregnancy

6. CDC Preconception Efforts • Summit • Select Panel Meeting • Recommendations • Supplement • Lectures/Speakers’ Bureau • Evaluations/Best Practices • Workgroups to develop • implementation strategies • TA to programs • Journal publications

7. Preconception Health Concept Measurement “How do we measure preconception health?”

8. Background • FDOH wants to assess, monitor and evaluate preconception health and interventions • CA has previously developed a preconception health report including indicators • No real consensus exists as to appropriate preconception health measures

9. CORE State Preconception Health Indicator Initiative Purpose • 7 states formed the initiative • CA, FL, MI, NC, RI, TX & UT • Review and evaluate potential indicators • Recommend an initial set of available core state indicators

10. North Carolina Alvina Long Valentin RN, MPH Sarah McCracken Cobb Texas Gita Mirchandani, PhD, MPH Charlotte Brooks, MEd Utah Nan Streeter, MS, RN Lois Bloebaum, MPA Shaheen Hossain, PhD California Moreen Libet, PhD Kiko Malin, MPH, MSW Delaware Charlan Kroelinger, PhD Florida Danielle Broussard, PhD Bill Sappenfield, MD, MPH Michigan Violanda Grigorescu, MD, MSPH Chris Fussman, MS CORE State Preconception Health Indicator Initiative

11. CORE State Preconception Health Indicator Initiative Assumptions • Indicators must be currently measurable on an annual basis(?)—either core or optional component. • Indicators need to be population-based and state level. • Indicators must be reasonably accurate & useful. • Indicators should not be unnecessarily duplicative. • Outcomes should not be included as preconception health indicators—previously defined. • Adolescents and men need their own set of indicators; therefore not included.

12. CORE State Preconception Health Indicator Initiative Process • Identify preconception health domains • Review available state data sets for potential indicators using domains • Identify potential indicators • Evaluate proposed indicators based on 6 criteria • Score indicators for selection based on 6 criteria • Select and recommend CORE indicators • Provide for public review and comment Expert panel input & comment at decision points

13. Domains General Health Status Chronic Conditions Emotional/Social Support Genetics/Epigenetics Health Care Infections Mental Health Nutrition/Physical Activity Reproductive Health / Family Planning Social Determinants Tobacco, Alcohol and Substance Use CORE State Preconception Health Indicator Initiative

14. CORE State Preconception Health Indicator Initiative State Level Data Sets • Abortion reporting • ART Surveillance System • BRFSS • Census / Current Population Survey • Cancer registry • PRAMS • Pregnancy Nutrition Surveillance System • STI reporting • Vital records

15. CORE State Preconception Health Indicator Initiative Indicator Evaluation Criteria • Public health importance • Policy/program importance • Data availability • Data quality • Indicator complexity

16. General Health Status Chronic Conditions Emotional/Social Support Genetics/Epigenetics Health Care Infections Mental Health Nutrition/Physical Activity Reproductive Health / Family Planning Social Determinants Tobacco, Alcohol and Substance Use CORE State Preconception Health Indicator Initiative Propose 45 Indicators in 11 Domains “Turn to your handout table”

17. CORE State Preconception Health IndicatorsChallenges & Issues • Still emerging field • Preconception health versus women’s health • Adolescents, older women and men • True population “at risk” • Limited services data by risk factor • Initial proposal already has 45 indicators • Competing surveillance priorities